Abstract
Introduction: Blood transfusion is a common practice among children with severe anaemia. A common assumption among physician is that transfusion of 5 ml/kg packed red cell will increase the haemoglobin of the recipient by 1 gm/dl. This study was aimed at assessing the effect of volume of blood product and hematocrit of donor blood in the rise of haemoglobin concentration after transfusion in children without active bleeding.
 Methods: A prospective observational study was conducted in 32 children aged between one to 15 years without active bleeding who received blood transfusion in Paediatric ward and Paediatric Intensive Care Unit of a tertiary care hospital in Nepal from December 2013 to November 2014. Haemoglobin levels before and after transfusion were compared and any adverse reactions that occurred during transfusion were recorded. Hematocrit of each donor blood was measured.
 Results: The overall rise of haemoglobin after transfusion of blood product with hematocrit of 53 ± 8.9 % at the rate 14.5 ± 6.0 ml/kg was 2.7 ± 1.4 gm/dl. The rise of haemoglobin after transfusion of whole blood with hematocrit of 38.8 ± 4.4% at the rate 15.5 ± 6.9 ml/kg was 1.8 ± 1.2 gm/dl. The rise of haemoglobin after transfusion of packed cell with hematocrit 57.0 ± 4.8 % at the rate 14.2 ± 5.8 ml/kg was 2.9 ± 1.4 gm/dl.
 Conclusion: This study supports the general consensus of 1 gm/dl rise of haemoglobin after transfusion of packed red cell at 5 ml/kg.
Highlights
Blood transfusion is a common practice among children with severe anaemia
The haematocrit of the blood product varied from 34 - 68% with mean of 53.0 % and standard deviation of 8.9
Chegondi et al in their retrospective chart review study to evaluate the haemoglobin threshold for red cell transfusion in children admitted to a paediatric intensive care unit reported that the mean (+ SD) pre-transfusion haemoglobin was 7.3 g/dl (+ 1.20) and the mean post-transfusion haemoglobin was 9.83g/dl (+ 1.97) after transfusing an average of 11.52 ml/kg (+ 9.94) of packed red blood cells.[9]
Summary
Blood transfusion is a common practice among children with severe anaemia. This study was aimed at assessing the effect of volume of blood product and hematocrit of donor blood in the rise of haemoglobin concentration after transfusion in children without active bleeding. It is common assumption among paediatricians that the transfusion of 5 ml/kg of packed red blood cell increases the haemoglobin (Hb) concentration by about 1 g/dL.[5] such assumption does not take into account the variances in the hematocrit of the packed red blood cell. The transfusion of calculated volume of blood in children has not been precise in low income setting like ours due to unavailability of paediatric blood pack and limited availability of equipment that control the rate and volume of transfused blood. This study presents an effort to correlate the effect of transfusion volume and hematocrit of blood products with haemoglobin increment after transfusion
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